"Before leaving for an international trip (travel, work, study, volunteer, etc.) you need to know your own vaccination status in order to assess a vaccination plan that takes into account not only the staff of the state of general health, also the destination, the type and duration of the trip.

Remember that some diseases, eliminated long time ago in Italy, are, in fact, still endemic or epidemic in some countries.

It 's always advisable before leaving, also, consult your doctor.

The existence of certain conditions, including pregnancy or therapeutic regimens, may, in fact, advise against travel to areas with different environmental and climatic conditions from the usual ones, or contraindicate pharmacological prophylaxis or vaccination. "

There are five types of malaria:

Plasmodium vivax (P. vivax) - milder form of the disease, generally not fatal. However, infected people still need treatment because their untreated progress can also cause a host of health problems. This type has the widest geographic distribution globally. About 60% of infections in India are due to P. vivax. This parasite has a liver stage and can remain in the body for years without causing sickness. If the patient is not treated, the liver stage may re-activate and cause relapses - malaria attacks - after months, or even years without symptoms.

Plasmodium malariae (P. malariae) - milder form of the disease, generally not fatal. However, the infected human still needs treatment because no treatment can also lead to a host of health problems. This type of parasite has been known to stay in the blood of some people for several decades.

Plasmodium ovale (P. ovale) - milder form of the disease, generally not fatal. However, the infected human still needs to be treated because it may progress and cause a host of health problems. This parasite has a liver stage and can remain in the body for years without causing sickness. Without treatment there is a risk that the liver stage re-activates and cause relapses after very long periods without symptoms.

Plasmodium falciparum (P. faliparum) - the most serious form of the disease. It is most common in Africa, especially sub-Saharan Africa. Current data indicates that cases are now being reported in areas of the world where this type was thought to have been eradicated.

Malaria vaccines are considered amongst the most important modalities for potential prevention of malaria disease and reduction of malaria transmission. Research and development in this field has been an area of intense effort by many groups over the last few decades. Despite this, there is currently no licensed malaria vaccine. Researchers, clinical trialists and vaccine developers have been working on many approaches to bring forward the availability of a malaria vaccine.

Yellow Fever

It's a viral disease transmitted by infected mosquitoes. The ‘yellow’ in the name refers to the fact that many patients suffer jaundice, a condition which gives skin a yellow pallor.

Yellow fever high-risk areas are tropical regions of Africa and Latin America. Infection causes a wide spectrum of disease, from mild
symptoms to severe illness and death in up to 50% of patients. No treatment beyond supportive care exists.

The World Health Organisation (WHO) estimates that 200,000 cases of yellow fever per year, leading to 30,000 deaths, worldwide each year. The number of cases has increased over the past two decades for a variety of reasons, including deforestation, urbanization, population movements and climate change.

Is yellow fever preventable?

Vaccination is recommended by the WHO as a preventive measure for travelers to, and people living in, areas where the disease is common. The vaccine provides immunity within one week for 95% of people who are vaccinated. The organisation says the current vaccine appears to provide protection for 30-35 years or more.

The WHO strongly recommends routine yellow fever vaccination for children in areas at risk for the disease.

The infection is spread from person-to-person by the fecal-oral route. That means that people get typhoid from food or water contaminated with the feces of infected people.

Typhoid symptoms include high fever, weakness, stomach pains, headache, loss of appetite, and sometimes a rash. Infection can spread to many other places in the body (such as bones) and can cause rupture of the intestine. It kills up to 30% of people who get it, if they are not treated.

Some people who become infected with S. Typhi become chronic carriers—they have no symptoms but have S. Typhiin their feces. Chronic carriers can spread S. Typhi to other people especially when handling food.

Antibiotic therapy reduces deaths and complications caused by typhoid fever. However, in recent years S. Typhi has acquired resistance to many of the antibiotics most widely available for its treatment. Typhoid vaccine can reduce the risk of illness in those who are exposed to S. Typhi.

According to the World Health Organization, 16 million people get typhoid every year around the world and about 600,000 die from the disease.

Typhoid is not common in the United States. Although 356 cases of typhoid fever were reported in the US in 2003, most of these infections are acquired during travel to other parts of the world or by contact with someone who is a carrier—either someone who has recently traveled or is a chronic carrier of S.Typhi.

During the past 15 years, the two typhoid vaccines licensed in the US have been widely used globally. These vaccines have largely replaced the old heat-phenol inactivated whole-cell vaccine in many countries, including the US.

An oral live-attenuated strain of S.Typhi—a weakened strain of S. Typhi that is taken by mouth. (Vivotif Berna; Berna Biotech SA).

A parenteral capsular polysaccharide vaccine—a piece of the bacterium that is given by injection. (Typhim Vi; Aventis Pasteur)

Polio

Polio is caused by intestinal viruses that spread from person to person in stool and saliva. Most people infected with polio (approximately 95%) show no symptoms. Minor symptoms can include sore throat, low-grade fever, nausea, and vomiting. Some infected persons (1 to 2%) will have stiffness in the neck, back, or legs without paralysis. Less than 1% of polio infections (about 1 of every 1,000 cases) cause paralysis. In some cases, the poliovirus will paralyze the muscles used to breathe, leaving the victim unable to breathe on his or her own. Many paralyzed persons recover completely. Those who do recover from paralytic polio may be affected 30 to 40 years later, with muscle pain and progressive weakness.

Before the polio vaccine, 13,000 to 20,000 people were paralyzed by polio, and about 1,000 people died from it each year in the United States. Most of those infected were elementary school children so it was often called ‘infantile paralysis.’

The incidence of paralytic polio peaked in the U.S. in 1952 with 21,000 reported cases and numerous deaths. Following licensure of the Salk (inactivated) polio vaccine in 1955, the incidence of the disease fell dramatically. The disease was further reduced by the advent of the Sabin (oral) polio vaccine in 1961. The last cases of paralytic polio from natural poliovirus in the U.S. were in 1979, and the most recent case from outside the U.S. occurred in 1993.

Today, polio has been eliminated from the U.S. and the entire Western Hemisphere, although it remains a threat in some countries. The World Health Organization set up an initiative to eradicate polio from the planet by the end of 2005.

Diphtheria is a serious disease that can cause death through airway obstruction, heart failure, paralysis of the muscles used for swallowing and pneumonia. It is caused by the bacterium Corynebacterium diphtheriae, which produces toxins that cause cell death both at the site of infection and elsewhere in the body.

Diphtheria usually begins with a sore throat, slight fever, and swollen neck. Most commonly, bacteria multiply in the throat, where a grayish membrane forms. This membrane can choke the person. Sometimes, the membrane forms in the nose, on the skin, or other parts of the body. The bacteria can release a toxin that spreads through the bloodstream and may cause muscle paralysis, heart and kidney failure, and death. Approximately 5% of people who develop diphtheria (500 out of every 10,000) die from the disease and many more suffer permanent damage.

In the 1920s, before the diphtheria vaccine, there were 100,000 to 200,000 reported cases in the United States each year. Because of the high level of immunization, only about one case of diphtheria occurs each year in the United States. However, in areas where the immunization rate has recently fallen (such as Eastern Europe and the Russian Federation), tens of thousands of people are suffering from diphtheria. The bacterium is still here—even though we do not see many cases. Our children are protected by being immunized and by everyone else being immunized too.

The diphtheria toxoid (inactivated toxin) vaccine offers the greatest protection against this disease. The fully immunized person who is exposed can become a carrier of the bacterium but may only develop a mild case, or may not get sick at all. But if not fully vaccinated, the risk of getting severely ill is 30 times higher.

Vaccines containing the whole cell pertussis component (DTP) are no longer recommended for use in the United States and are not listed here although they are used in many other countries. Vaccines containing lower amounts of diphtheria toxoid—abbreviated with a small d—are utilized in persons 7 years of age or older.

Tetanus

Tetanus (Lockjaw) is caused by toxin-producing spores of a bacterium, Clostridium tetani that inhabit the soil and the bowels of animals and humans. Unlike other vaccine-preventable diseases, it is not spread from person to person. Tetanus infection is most often the result of wound contamination in an unimmunized person or someone who has not had vaccine boosters in many years. Tetanus may occur following delivery in the newborn babies of unimmunized women. It may also occur following puncture wounds, animal bites, burns, abrasions and surgery.

The tetanus toxin causes severe muscle contractions, or spasms. Fever, sweating, elevated blood pressure, and rapid heart rate may also occur. Spasms of the vocal cords or the muscles of respiration can interfere with breathing, and pneumonia is common. Contraction of muscles can be so severe that the spine or other bones are fractured.

Between 40-60 cases of tetanus are reported in the United States each year, and 30% of those infected die. Death is more likely in newborn infants of unimmunized mothers and patients over 50 years of age.

Vaccines containing the whole cell pertussis component (DTP) are no longer recommended for use in the United States and are not listed here although they are used in many other countries. Vaccines containing lower amounts of diphtheria toxoid—abbreviated with a small d—are utilized in persons 7 years of age or older. Pertussis component-containing vaccines are not available for children 7-9 years of age.

Rabies

Rabies is an acute and deadly disease caused by a viral infection of the central nervous system. The rabies virus is most often spread by a bite and saliva from an infected (rabid) animal (e.g., bats, raccoons, skunks, foxes, ferrets, cats, or dogs). In the United States, rabies is most often associated with bat exposures. However, there have been rare cases in which laboratory workers and explorers in caves inhabited by millions of bats were infected by rabies virus in the air.

Virtually 100% of those infected with rabies who do not receive the vaccine will die. Rabies illness includes rapidly progressing central nervous system symptoms such as anxiety, difficulty swallowing, and seizures.

Although less than ten human rabies fatalities occur in the United States annually, as many as 40,000 Americans receive the vaccine each year after contact with animals suspected of being rabid. An additional 18,000 people get the vaccine before exposure as a preventative measure.

Worldwide, at least 4 million people are vaccinated each year for rabies. The number of deaths that rabies causes each year is estimated to be at least 40,000, and as high as 70,000 if higher case estimates are used for densely populated countries in Africa and Asia where rabies is epidemic. India, with a very large population of stray, ownerless dogs, has about half of all cases of rabies worldwide. Between 30-60% of human rabies cases occur in children under 15 years of age.

Hepatitis B virus (HBV) is transmitted from one person to another through blood and body fluids, and primarily infects the liver. In the United States, it is most commonly spread through sexual contact or injection drug use. Health care workers and others exposed to infected blood or body fluids are also at high risk for infection. Worldwide, it is most commonly spread to infants by their infected mothers.

Japanese Encephalitis

Japanese encephalitis (JE) is a mosquito-borne disease due to a virus similar to the virus that causes yellow fever. It occurs throughout most of Asia and parts of the Western Pacific. Only a small fraction of people infected with JEV develop encephalitis but it is estimated that there are 35,000-50,000 cases each year. Of those who develop encephalitis as many as 20-30% will die, and about half (50%) of the survivors will have permanent brain damage. In areas where infection is endemic, almost everyone has been infected by 15 years of age.

JE occurs primarily in rural areas where pigs are intensively raised, particularly in regions with rice production. In vertebrate hosts, like pigs and wading birds, the JE virus is amplified, although the virus does not cause illness in pigs. Pregnant sows that are infected with JE virus, however, often have stillbirths so farmers often immunize their sows. JE virus is spread by infected mosquitoes which breed in pools of water: a single rice paddy, for example, can generate about 30,000 mosquitoes per day.

During the first half of the 20th century, JE occurred primarily in Japan, Korea, Taiwan and China. Japan has greatly reduced JE as a result of widespread immunization of children and the protection of herds of pigs. Vaccination has also reduced JE in China. In recent decades, however, JE has spread to Southeast Asia, India, Bangladesh, Sri Lanka, Nepal, Saipan and Australia. The reasons for the spread are not certain but scientists think it may be due to increased pig farming near rural rice paddies in these areas, or the virus may be spread by migrating birds and wind-blown mosquitoes.

In endemic areas, JE virus infection occurs primarily among children. However, travelers of all ages have become infected with JE virus. The military has estimated that among the unimmunized, between one and two people in 100,000 per week are infected with JE virus. Scandinavian tourists to these regions have been estimated to be infected at a rate of one in 275,000 with half developing encephalitis. The risk for travelers acquiring JE infection depends on the season of travel, destination (rural areas being much higher risk than urban areas), duration of stay, and likelihood of mosquito exposure (dusk and night time are the preferred times for biting mosquitoes).

Cholera

Cholera is an acute diarrhoeal infection caused by the enterotoxin subunit-A of Vibrio cholerae.

Cholera is a water-borne infection caught through ingestion of faecally contaminated water or shellfish.

Person-to-person spread via the faeco-oral route can also occur.

The incubation period is usually 2-5 days. However, it can sometimes be a few hours.

75% of those infected are asymptomatic.

Cholera is prevalent in areas with poor sanitation and food and water hygiene and constitutes a major global public health problem.

Without treatment, severe infection has a mortality rate of 30-50%.

The disease is endemic to parts of Africa, Asia, the Middle East and South America.

Large outbreaks are common after natural disasters or in populations displaced by war, where inadequate sewage disposal and contaminated water exist.

An average of only 10 cases of cholera are imported into the UK annually. The most common serotype is V. cholerae El Tor and most infections are acquired on the Indian subcontinent.

The risk of cholera for most travellers to endemic areas is very low.

Cholera vaccine is not licensed for use as an infection control tool in the management of cholera contacts or for prevention of travellers' diarrhoea.The vaccination must not be used as an alternative to standard hygiene precautions, which remain the most effective preventative measures for all food- and water-borne diseases.Immunisation can be considered for the following:Aid workers helping in disaster relief or refugee camps.Backpackers travelling to remote areas where access to medical care is likely to be limited.

Certification of vaccination against cholera is no longer a requirement for entry into any country.

Meningitis

Meningococcal disease is a leading cause of bacterial meningitis in teens. Meningitis is a dangerous inflammation of the lining of the brain and spinal cord that usually results from viruses or bacteria. Not all types of meningitis can be prevented with vaccines. Fortunately, immunization does protect against four types of meningococcal disease.

Under the Affordable Care Act, many health insurance plans will provide free preventive care services, including checkups, vaccinations and screening tests, to children and teens.

Why do teens need a meningococcal vaccine?

Of the 1,000- 2,600 people who get meningococcal disease each year, one-third are teens and young adults. Ten percent to 15% of those who get sick with the disease will die, even with antibiotic treatment. Up to 20% will have permanent side effects, such as hearing loss or brain damage. This is why immunization against meningococcal disease so important. It can help prevent this serious disease.

Which meningococcal vaccines are available?

In the U.S., three meningococcal vaccines are available:

Meningococcal polysaccharide vaccine (MPSV4), sold as Menomune

Meningococcal conjugate vaccine (MCV4), sold as Menactra and Menveo

These meningitis vaccines can prevent four types of meningococcal disease, which represents about 70% of the cases in the U.S.

Menactra is the preferred vaccine for people age 9 months to 55 years old and Menveo is approved for those 2 to 55 years old. That's because they provide more lasting protection and decrease carrier rates of meningococcal bacteria, which may help prevent its spread. The doctor or nurse injects one dose into the muscle. If MCV4 is not available, you can use MPSV4. The doctor or nurse injects one dose beneath the skin. Menomune is the only meningococcal vaccine licensed for use in people over 55.

Either vaccine may be given at the same time as other vaccines. The current recommendation for teens is one dose at age 11 and one does at age 16.

Who needs a meningococcal vaccine?

The CDC recommends a meningococcal vaccine for:

All children ages 11-18 or certain younger high-risk children

Anyone who has been exposed to meningitis during an outbreak

Anyone traveling to or living where meningitis is common, such as in sub-Saharan Africa

Military recruits

People with certain immune system disorders or a damaged or missing spleen

The American Academy of Pediatrics recommends the first dose of vaccine be given at age 11 or 12 and then a second dose, the booster, should be given between age 16 to 18.